Don't blame hospital staff for the treatment of dementia sufferers

Andrea Gillies suggests that hospital care for people with dementia is deficient because staff don't know, or don't care, about looking after these patients (The cruelty of neglect, 18 November).

"Hospitals run on information and on a chain of command," she says. This is true and, as a consultant physician, I know that a major problem is that very often staff don't get the information we need: someone arrives from a care home with a brief note saying that he or she "seems less responsive" or "has gone off their legs". There may be no timescale and, crucially, no information about what the person can or can't do normally, what they like to do, how well they can communicate, or anything else which allows us to understand them as a person. It can take several days and numerous phone calls to get this information.

Such a problem can even arise when the person lives in their own home: they arrive in hospital unaccompanied, disoriented and afraid. If the ambulance crew who bring them don't give us a contact telephone number then we start on the same merry-go-round.

Gillies refers to the issue of patients "pacing up and down", saying that "pacing isn't tolerated in hospitals". But it's not just pacing: many patients keep pulling out their intravenous drips; refuse to take their medicines; call out repeatedly for their long-dead brother (keeping the rest of the ward awake in the process); or, if left alone for even a few moments, stagger about, fall and injure themselves.

Of course staff need to respect and care for these patients and to have the training to enable them to do so. But looking after demented patients in what, to them, is an alien environment is hugely demanding of time and patience and can be virtually impossible in a busy acute medical ward: on many occasions I have witnessed nurses coming off shift in tears, shaking with frustration and distress because they have tried to provide care to several demented, wandering patients while also looking after other acutely ill patients – knowing that they are doing both jobs badly but are unable to get any additional help.

Some staff respond to these difficulties by becoming detached or even uncaring (an acquaintance of Gillies was told: "There isn't time to deal with her tantrums"). Whenever this happens we must challenge such behaviour, but we also need to understand some of the factors that give rise to it.

When it comes to discharging people whose health is less than perfect it isn't true that "NHS staff don't understand that people live their lives with dementia, and that this is as well as they are ever going to be"; we understand this only too well. Those who don't understand it are social workers and community care managers who demand all sorts of assessments and who have absolutely no sense of urgency about facilitating patients' discharge, such that delays of two or three weeks are not unusual.

Every neglected patient in hospital is one patient too many. However, hospital care for dementia patients is much more complicated that it may seem.

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